Healthcare Provider Details

I. General information

NPI: 1285579474
Provider Name (Legal Business Name): ST JUDE CARES NON MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 TAYLOR DR
HUNTINGTON BEACH CA
92648
US

IV. Provider business mailing address

17011 BEACH BLVD STE 900
HUNTINGTON BEACH CA
92647-5998
US

V. Phone/Fax

Practice location:
  • Phone: 562-486-8370
  • Fax: 562-486-8370
Mailing address:
  • Phone: 562-486-8370
  • Fax: 562-486-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MAINE JARING
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-486-8370